Organization
ADVANCED FOOT & ANKLE CENTER, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KENNETH E BLOOM DPM (OWNER)
(704) 662-8336
Entity
Organization
Contact information
Practice address
137 PROFESSIONAL PARK DR., SUITE C, MOORESVILLE, NC 28117
(704) 662-8336
(704) 662-8525
Mailing address
137 PROFESSIONAL PARK DR, SUITE C, MOORESVILLE, NC 28117-6540
(704) 662-8336
(704) 662-8525
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
001752814
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5905761
—
NC
Enumeration date
11/30/2006
Last updated
05/26/2010
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